Exam 4 - Non-opioid analgesics and anti-inflammatories Flashcards
Which non-opioid inhibits cyclooxygenase so prostaglandins cannot be formed and is sensitize to pain receptors to substances such as bradykinin. Also it is more effective if given before painful stimuli.
Aspirin - ASA - acetylsalicylic acid
Which non-opioid works on COX 3 in the CNS?
Acetaminophen
What 5 things does acetaminophen NOT do?
- Not anti-inflammatory
- Inhibit platelet aggregation (not an anticoagulant)
- Irritate the GI tract
- Cause bronchoconstriction
- No effect on uric acid
NSAIDs inhibit what 3 things?
- Inhibit prostaglandin synthesis
- Inhibit cyclooxygenase so that prostaglandins are not formed
- Inhibits cytoprotective PG as well as PG associated with inflammation
What are the selective/non-selective enzymes affected in NSAIDs?
Non-selective: COX-1 / COX-2
Selective: COX2
What 3 things are an indication of use for Aspirin?
- Fever
- salicylate for analgesia
- throbbing pain (due to inflammation)
Acetaminophen and aspirin are equally ______ and ______, but acetaminophen is less useful clinically bc it is not ____________. Acetaminophen also has no effect on ___ acid and no ______ effects
efficacious potent anti-inflammatory uric anticoagulant
3 dental uses for NSAIDs and 5 medical uses for NSAIDs
Dental: pain(analgesic), fever(antipyretic), inflammation (anti-inflammatory)
Medical: osteoarthritis, RA, gouty arthritis, fever, dysmenorrhea, pain
5 clinical effects of Aspirin
- Analgesic (mild to mod.)
- Antipyretic (fever reduction- vasodilation and sweating)
- Anti-inflammatory -decreased erythema and swelling (ALL DENTAL PAIN)
- Uricosuric
- Antiplatelet - irreversible for life of platelet (7-10days)
How does high/low doses of Aspirin affect uric acid?
High doses (3+g/day) = excretion of uric acid in urine (tx for gout) Low doses (<1g/day) = uric acid retention (take probenecid to excrete uric acid/aspirin antagonizes)
At what dose does aspirin reduce the risk for clots?
81 mg
What are 6 general adverse side effects of aspirin?
- GI problems
- Bleeding
- Reye’s syndrome (with viral infections)
- Salicylism (6-10 g in adults)
- Hypersensitivity/allergic reactions
- Aspirin burn
What happens in Aspirin poisoning or salicylism?
confusion, tinnitus, dizziness, nausea, vomiting, headache, dimness of vision, hyperthermia, hyperventilation, respiratory alkalosis, renal loss of bicarb -> respiratory and metabolic acidosis -> death
How does aspirin affect bleeding?
Causes irreversible effect on platelets by reducing platelet adhesiveness/aggregation interfering with ADP which inhibits production of prothrombin causing hypoprothrombinemia
What are the 2 major adverse side effects of acetaminophen?
- hepatoxic
2. Increased bleeding (INR)
What 4 groups of people is acetaminophen contraindicated in?
- liver disease or dysfunction
- patients treated with drugs that are dependent of liver function
- alcoholics
- patients on warfarin
What are 10 general side effects of NSAIDs?
- Reversible effect on blood platelets
- Increased risk of MI/stroke
- Hypertension
- Compromised rental function
- GI complications (bleeding/perforation)
- CNS complications
- Skin reactions
- Respiratory complications (do not use if asthmatic)
- Hypersensitivity
- Kidney damage
How do NSAIDs affect the kidney?
inhibiting prostaglandins shuts down renal blood flow -> renal necrosis. (short term ok)
Whats the dose of NSAIDs that gives anti-inflammatory effects?
3500 mg - for pain and arthritis. (Difficult bc chronically will lead to GI ulceration/bleeding)
Whats the optimal analgesia dose of ibuprofen to relieve dental pain?
400 mg
Whats the optimal analgesia dose of ibuprofen to chronic inflammatory pain?
400-800 mg 4x/day NOT exceeding 3200 mg - takes days/weeks to reach anti-inflammatory effects
Which non-opioid analgesic gives up to 7 hours of pain relief?
naproxen (inflammatory dosing: less than 12 hours, peaks after 2 weeks)
